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NAME <br />ADDRESS <br />(Include Facility NamelLacation if Ihfferentl <br />CI. BOX r - <br />FACILITY HORIZON <br />LOCATION -A ? <br />LANCE WADE. ,.NE MANi <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (OMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />(SUER MH) <br />F - FINIAL MNTRS <br />=Z93Q:INTistr: rNONIC: TQTR Tn !"Gl A'1-TTY <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION N0. FREOUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br />.; MEASUREMENT <br />I <br /> PERMIT R I' R l f <br /> REQUIREMENT A V ( DAILY MI X ; '?' . ' : l;'IJN-F <br /> SAMPLE <br /> MEASUREMENT1 <br /> PERMIT P L)R! 'S <br />` <br /> REQUIREMENT DAILY ,^?X <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r .: t w. a f <br /> REQUIREMENT j .r t <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT I <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br />REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT ' <br />NAMEffITLE PRINCIPAL EXECUTIVE OFFICER I ref f> under penalq of law that Ihi% document and all attachments were <br />h <br />d TELEPHONE DATE <br />prepared under mi din •timi or suprnision in accordance wit <br />a system designe <br />_ to a ,sure that qualified Per.nnnel properh gather and evaluate the information <br />suhmitied. Based on m) inyuin of the prrson or pers ns who manage the system. <br />or th- persons directl7 rnponsible for gathering the information, the information <br />and complete. <br />to the best of my krwniiedge and belief <br />true <br />arrurate <br />submits d is <br />, <br />, <br />, <br />, SIGNATURE OF PRINCIPAL EXECUTIVE <br />I am aware that there ore sig'nificam PenuBia. fur submitting false information. <br />TYPED OR PRINTED` including the Fxmihility of fine and imprisonment for knowint: siotatioo. <br />OFFICER OR AUTHORIZED AGENT AREA <br />CODE NUMBER <br />YEAR <br />MO <br />DAY <br />COMMtNIS ANU tAPLANAIIUN Ur ANY vwLAIIVrvD (nererencr an duncnments Here/ <br />EPA Form 3320-1 (Rev. 3/99) Previous editions may be used. ' ?' - `' `T nS .NRW4'pa>If{OfRI.